Cirrhosis

Cirrhosis is the common endpoint of a wide variety of chronic liver disease processes which cause hepatocellular necrosis. Cirrhosis can be diagnosed with ultrasound, CT, and MRI, and these imaging modalities can also be used to evaluate for possible sequelae of cirrhosis, such as portal hypertension or hepatocellular carcinoma.

Epidemiology

The demographics of cirrhosis reflect the underlying causes. Alcoholism and viral hepatitis from IV drug use or an endemic region are common causes.

The distribution of underlying aetiology will vary regionally, with viral hepatitis being much higher in the developing world, especially Asia. A typical distribution of causality in Western nations is a follows 4:

Clinical presentation

The diagnosis is made either at screening for cirrhosis due to known risk factors, elevated liver enyzmes, or discovered incidentally in an examination for nonspecific symptoms (e.g. right upper quadrant pain). It may also present due to one of its complications:

Pathology

Focal hepatocellular necrosis caused by a variety of insults (see above) is accompanied by the three characteristics of cirrhosis 3:

fibrosis

nodular regeneration

distortion of hepatic architecture

Although traditionally cirrhosis has been divided into micro- and macronodular cirrhosis, many entities begin as micronodular (<3 mm) 9 and progress to macronodular (e.g. alcoholic cirrhosis) and thus it is of limited utility as a classification scheme 4.

MR angiography or a balanced steady state free precession sequence may also be used to asses portal vein patency and portosystemic collaterals.

Treatment and prognosis

Treatment depends on the underlying aetiology and presence of complications. One of the key roles of diagnostic radiology is detection of hepatocellular carcinoma. Interventional radiology can be very helpful for treatment of portal hypertension and its complications (e.g. TIPS, ascites drainage), as well as chemoembolisation or radiofrequency ablation of HCC.

Complications

History and etymology

The word cirrhosis derives from the greek word "κιρρόειν" ("to turn reddish yellow" or "tawny"). Laennec was the first to use the term to describe the macroscopic appearance of fibrotic changes in a liver with alcoholic cirrhosis.

Differential diagnosis

There are several conditions than can potentially mimic cirrhosis on imaging 10: